A CLINICAL STUDY ON THE PROGNOSIS OF RENAL CARCINOMA

WITH REFERENCE TO FACTORS ON THE PART OF HOST

Abstract

Seventy-three cases of renal cell carcinoma (57 male and 16 female) were investigated clinically mainly for the course and prognosis of the disease and based on the results obtained, a proposal was made of a new system of classification for the evaluation of prognosis and the clinical utility of the system was discussed.
1) Fever, erythrocytic sedimentation rate, C-reactive protein and serum protein fractions, changes occurring in the host of this malignancy to which no great importance has been attached, were demonstrated to be factors of great value in the prediction of prognosis. Pyrexia was noted to exist in 34 (46.6%) of 73 cases; the 3-year survival rate was 39.9% for cases with pyrexia as against 68.8% for those without pyrexia, indicating thus clearly the association of poorer prognosis with fever. Increased sedimentation rate was seen in 38 (62.3%) of 61 cases; the 3-year and 5-year survival rates were 40.0% and 30.6% respectively for cases with increased sedimentation rate and hence definitely lower than corresponding values for those showing normal sedimentation rate of 80.4% and 52.3% respectively. Of 64 cases, 38 (or 59.4%) were found to be CRP-positive, of which 37.9% survived 3 years, whereas 79.8% of CRP-negative cases did the same. Among perturbations of serum protein fractions most prominent was an increase of α₂-globulin, which was noted in 32 (62.7%) of 51 cases; the 3-year and 5-year survival rates for cases with elevated α₂-globulin were estimated to be 35.5% and 28.4% respectively as against corresponding values for those with normalcy of this protein fraction of 75.5% and 57.7% respectively, the difference between both groups of cases being thus really striking.
2) A method was devised for foretelling the course of renal cancer, which is known to vary widely with different cases. This method is based on the finding that very quick progress of renal cancer is associated with fever, increased sedimentation rate, positivity of CRP and elevated serum α₂-globulin, while slow progress of the disease, with normal body temperature, normalcy of sedimentation rate, negative CRP and normal serum protein pattern. By classifying a group of cases where the disease follows a course of the former type as type I (or quick type) and another group of cases whose disease progresses slowly as type II (slow type), it was found that 90% of renal cancer cases fell under either type I or type II.
3) A striking difference was noted between both types in prognostic outlook, the 3-year and 5-year survival rates having been estimated at 38.4% and 27.2% respectively for type I and 91% and 51% for type II.
4) A study of changes in the aforementioned 4 signs before and after nephrectomy showed that the 4 signs all tended to be absent after surgery in cases of type I but would not be obliterated in those with metastatic lesion. In type II the signs tended to be negative before and after surgery. The occurrence of metastasis of malignancy following nephrectomy was associated with reappearance of all the 4 signs in type I but with no gross changes in them in type II. No conclusive statement can be made yet, however, on this point because of scantiness of cases thus far available.
5) This new system of classification of renal cell carcinoma was demonstrated to have the following clinical utility value: (1) it, unlike any other systems of classification hitherto proposed, permits to predict prognosis merely on first routine examination even in cases with metastasizing carcinoma or in those with undermined grade of malignancy histopathologically; (2) it warrants to conclude that whereas in cases classified as type I 5-year survival can safely be interpreted as signifying complete cure, those of type II may require several decades of follow-up; (3) it enables early detection of relapse by making use of the 4 signs; and (4) it helps to decide therapeutic policy to be taken in